Financial assistance programs & policies
About the financial assistance program
Northwell Health is committed to providing accessible, affordable care to the communities we serve. Through our financial assistance program, we provide discounted services based on financial need. Use our online application or, if you prefer, apply by mail or by phone.
Income guidelines
The program is designed to help people who have received emergency or other medically necessary services. Eligibility for financial assistance is based on current income and family size, as shown below.
| Family size | Less than or equal to |
|---|---|
| 1 | $78,250 |
| 2 | $105,750 |
| 3 | $133,250 |
| 4 | $160,750 |
| 5 | $188,250 |
| 6 | $215,750 |
| For each additional person, add | $27,500 |
Application process
When completing an application for financial assistance, please remember:
- You are encouraged to apply for financial assistance within 90 days from the first post-discharge date noted on the statement; however, you are permitted a minimum of 240 days to apply and submit a completed application.
- To avoid delays, please attach copies of all required documentation—including checks, pay stubs and/or statements—that support the income reported on your financial assistance application. In addition, please provide copies of all bills and statements you would like us to review as part of your application. Note: We reserve the right to request additional documentation related to resources for patients with household incomes under 150% of the federal poverty level.
- Once we receive your completed application, you can disregard any bills or statements until you receive written notification regarding your financial assistance application.
- Applicants for financial assistance will be expected to fully cooperate in applying for any applicable public insurance program (e.g., Medicaid, Child Health Plus, etc.) that Northwell Health believes they may be eligible for.
- If an incomplete application is received, Northwell Health will provide written notice describing additional information or documentation required to determine eligibility. You will be given 30 days to provide this information. The normal billing cycle will continue, but any extraordinary collection actions will be suspended during this time.
- Your application will be kept strictly confidential.
Apply for financial assistance online
Use our online form to apply for financial assistance. You can upload your documents and sign from the comfort of your home. Please see below for PDF versions of the form available in other languages.
Apply by mail
Although we encourage you to apply online for fastest turn around time, you can still apply by mail. To apply for financial assistance, please download, print, sign and mail us a completed copy of the application.
For help applying, contact us online or call (800) 995-5727 for additional help or information. We offer the application in several languages:
Mailing addresses
Note: The Northwell Health option below includes all Northwell hospitals except Northern Westchester Hospital, Peconic Bay Medical Center and Phelps Hospital.
Northwell Health Northern Westchester Hospital | Peconic Bay Medical Center Phelps Hospital |
After applying
After submitting a completed application, including all requested documentation, you can disregard bill(s) received until a final decision is made. We will contact you within 30 days, either by telephone or by mail, to inform you of the decision.
If your application is approved: We will let you know your adjusted account balance. If you need additional help with the new balance, please contact us online or call (888) 214-4066 so we can help set up a customized monthly payment plan.
If your application is not approved: You can appeal the decision by submitting additional information and/or supporting documentation to the applicable mailing address above, based on the respective hospital facility. If you do not wish to appeal the decision, please contact us online or call (888) 214-4066 so we can help set up a customized monthly payment plan.